Abstract Background Cardiovascular changes in patients with Juvenile idiopathic arthritis (JIA) are linked to chronic inflammation and endothelial dysfunction, which could increase both morbidity and mortality risks. There are limited studies assessing the roles of laboratory testing, imaging, and biomarkers in cardiovascular changes in children. Objective To assess cardiovascular changes and endothelial dysfunction in children with JIA by measuring E-selectin levels, flow-mediated dilation (FMD), carotid and aortic intima-media thickness (CIMT, AIMT), and echocardiographic parameters. Methods This is a cross-sectional controlled study with nested follow-up at the pediatric rheumatology unit of Ain Shams University Hospital, including 57 JIA patients and 30 matched healthy controls. Patients included JIA subtypes: systemic, oligoarticular, and polyarticular. The study assessed JIA patients in both activity status based on JADAS-10 scores. E-selectin levels, FMD, CIMT, AIMT, and echocardiography parameters were collected in both groups. Receiver-operating characteristic (ROC) curves assessed the predictive value of E-selectin. The impact of therapeutic approach, disease activity, and JIA subtype on vascular and cardiac indices was assessed. Results Median E-selectin levels were significantly higher than healthy controls (945.9 ng/mL vs. 187.15 ng/mL; p-value < 0.001). Levels were higher during active disease (1093 ng/mL) than during remission (749.6 ng/mL); however, levels were comparable across JIA subtypes (p-value = 0.747). ROC analysis demonstrated excellent discriminatory ability between JIA patients and healthy controls during both active disease and remission phases, with high sensitivity and specificity. FMD percentages were comparable across groups. Although oligo-JIA patients showed higher absolute FMD values, no significant difference was observed in FMD percentage across groups. CIMT remained normal in all groups; however, AIMT was unexpectedly higher in patients during remission. Echocardiography revealed asymptomatic valvular abnormalities in 19.3% of JIA patients and reduced left main coronary artery diameter (1.6 mm vs. 2 mm; p-value = 0.036). JIA patients receiving biological therapies had lower AIMT during disease activity, with improved FMD and left myocardial performance index (MPI) during remission compared to patients receiving non-biological DMARDs. Conclusion Subclinical endothelial dysfunction and cardiovascular changes may persist during clinical remission in patients with JIA. These findings suggest that E-selectin may reflect inflammatory and endothelial changes in JIA. However, further longitudinal studies are required to determine whether E-selectin can reliably differentiate disease activity states over time. These findings highlight the importance of cardiovascular assessment and follow-up in JIA patients. Biologic therapies were associated with more favorable cardiovascular parameters; however, causality cannot be established.
Shousha et al. (Mon,) studied this question.